Ajou University Medical Center develops new method to classify strokes

Lee Han-soo  Published 2020.05.14  16:03  Updated 2020.05.14 16:29


A research team at Ajou University Medical Center has developed a new, phased method to classify strokes called CIVIL -- Clinical Information, Vital signs, and Initial Labs.

Professors Hong Ji-man (left) and Lee Seung-eun

The team, led by Professors Hong Ji-man and Lee Seung-eun at the hospital, analyzed a prospective database of regional emergency and stroke centers by focusing on clinical information, vital signs, and initial labs of 1,599 patients suspected of acute stroke from an automatically stored electronic health record.

By using the new method, people with no medical background can also classify strokes, the team said in a news release on Thursday.

The screening system classifies strokes into three stages. Stage 1 is to diagnose if the patient has a stroke or not, Stage 2 diagnoses if the stoke is either hemorrhagic or ischemic, and Stage 3 identifies whether an ischemic stroke is an acute large artery occlusion that requires urgent revascularization, according to the press release.

Evaluation items in the step-by-step stroke screening system CIVIL (Clinical Information, Vital signs, Initial Labs).

In detail, those included in Stage 1 were mostly younger people of lower than 40 years of age who had no risk factors for stroke and hemiplegia, and low initial blood pressure. In most cases, the patients were not suffering from a stroke. '

Stage 2 consisted mainly of the cases of deteriorated consciousness, and the patients were relatively young, less than 60 years old. They had high initial blood pressure and low-risk factors for stroke. In such cases, most of the patients were diagnosed with hemorrhagic strokes.

Stage 3 was accompanied by ocular deviation, a symptom where eyes shift to the left or right, unable to walk due to hemiplegic, and speech disturbances. In many of the cases, it was necessary to break through blocked blood vessels through emergency revascularization quickly.

The team found that the possibility of acute large-artery occlusion, which requires emergency revascularization, increased by about 21.7 times when the patient showed ocular deviation symptoms, about 2.2 times when there was arm paralysis, and about 2.4 times when the patient showed speech disorder.

A graph of the research results using the CIVIL system.

The classification is based purely on physical symptoms, visible medical history, biomedical signs, and basic tests that can be easily obtained from patients and their guardians before conducting time-consuming imaging tests, such as CT and MRI, the team said. Therefore, it will be helpful if everyone learns the classification so that they may quickly select the type of stroke during urgent situations, it added.

"This screening system is intended to diagnose the Stage 3, which is particularly sensitive to treatment," Professor Hong said. "This is because if the treatment time is delayed due to the inability to screen the three stages quickly, it is very likely that a person will suffer a lifelong disability even if he or she avoids death."

Professor Lee went on to say, "In the case of severe stroke, most people cannot express or act on their own, and as someone must screen the patient promptly before they can reach a doctor to receive a proper diagnosis. Therefore, we believe that the public should learn the three stages.”

The results of the research were published in the journal PLOS ONE on April 15, with the title of the "Stepwise stroke recognition through clinical information, vital signs, and initial labs (CIVIL): Electronic health record-based observational cohort study."

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